Medicaid Work Requirements Stir Controversy

January 12, 2018

New guidance unveiled this week would allow states to impose work requirements on Medicaid recipients, but one physician advocacy group is not on board.

Welcome to Practice Rounds, our weekly column exploring what's being covered in the larger world of healthcare.

Medicaid Work Requirements
The Trump administration this week unveiled guidance which allows states to impose work requirements on Medicaid recipients. Specifically, states would be able require "able-bodied" Medicaid recipients to work, volunteer or participate in job training in order to keep their health insurance, NPR reports. In a tweet, CMS Administrator Seema Verma said the guidance would, "...only apply to able bodied, working age adults and outlines protections for individuals determined to be medically frail or suffering from opioid addiction and other substance use disorders." Already, 10 states have shown interest and filed applications to implement these requirements.


The American College of Physicians (ACP) issued a statement saying it strongly opposes making access to health care coverage through Medicaid conditional on an individual's employment status. "Medicaid was designed as a health care program, to provide vulnerable members of our society with access to care they badly need. Work requirements impose an additional, unnecessary barrier to allowing patients access to vital health care services for people who need access and coverage the most," Jack Ende, MD, President of the ACP, said in a statement.

Azar on Track
Alex Azar, former pharmaceutical executive, is on track to become the next Health and Human Services Secretary, according to Politico. Azar has won the support of Republicans as well as at least one centrist Democrat (Joe Manchin, W.V.), making him likely to get confirmed when the vote reaches the Senate floor later this month. Before his long run as an executive at Eli Lilly, Azar worked at HHS under former President George W. Bush as general counsel and assistant secretary in HHS. Politico reports Azar is a staunch supporter of conservative healthcare ideas, such as selling insurance across state lines. 

MGMA Sends Letter
The Medical Group Management Association (MGMA) sent a letter to Verma this week asking the agency to release eligibility information surrounding the Merit-based Incentive Payment System, as part of the Medicare Quality Payment Program. Specifically, CMS has not released information on the number of physicians who are included and excluded from MIPS in 2018, despite raising the low-volume threshold from $30,000 in Medicare Part B allowed charges or fewer than 100 Part B beneficiaries to $90,000 in Part B allowed charges or fewer than 200 Part B beneficiaries. MGMA says CMS is requiring 365-day reporting for MIPS in 2018, which means eligibility information about this year should have already been released.

AMA Crunches the Numbers
The American Medical Association released a study this week about the impact physicians have on the economy. In total, the group says physicians support 12.6 million jobs and generate $2.3 trillion in economic activity. The study, from the AMA, aims to quantify the economic boost that 736,873 patient care physicians provide. According to the AMA, the report found that every dollar applied to physician services supports an additional $2.84 in other business activity.

Quote of the Week
This Doctor's Least Favorite Time of Year
"I hate this time of year. It's cold, it's dark, the holidays are over, and the holiday bills are coming. And for physicians and for patients, it's really the darkest time of year."

Melissa Young, MD, endocrinologist, Freehold, N.J.